UNSAFE DISPOSAL OF CHILD FECES IN INDONESIA Cara Pembuangan Tinja Balita Yang Tidak Aman di Indonesia Sri Irianti1, Puguh Prasetyoputra2 1
National Institute of Health Research and Development, Indonesian Ministry of Health 2 Research Center for Population, Indonesian Institute of Sciences Email:
[email protected] Received: 21 March 2018; Revised: 7 May 2018; Accepted: 22 June 2018 ABSTRAK
Studi terdahulu menunjukkan bahwa praktik pembuangan tinja balita yang tidak aman meningkatkan risiko penyakit diare, termasuk di Indonesia. Akibatnya, pemahaman faktor-faktor di balik praktik semacam itu sangat penting dalam menghentikan transmisi diare. Namun faktor-faktor yang terkait dengan praktik pembuangan tinja balita yang tidak aman di Indonesia belum dipahami dengan baik. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang terkait dengan praktik pembuangan tinja balita yang tidak aman di Indonesia. Penelitian ini menganalisis data dari Survei Demografi dan Kesehatan Indonesia (SDKI) 2012. Model regresi probit dibuat berdasarkan data dengan efek marjinal rerata (Average Marginal Effect) dan selang kepercayaan (SK) 95% sebagai besaran hubungan. Variabel penjelas dikategorikan menjadi tiga kategori yaitu variabel spasial, variabel lingkungan, dan variabel sosio-demografi. Penghapusan listwise menghasilkan sampel analitik akhir sebesar 16.368 anak balita yang tinggal dalam 13.685 rumah tangga. Hasil analisis menunjukkan bahwa prevalensi pembuangan tinja balita yang tidak aman adalah sebesar 42,63% (SK 95%: 41,87-43,38). Tinggal di daerah perkotaan, tingkat pendidikan ibu yang lebih rendah, tidak memiliki fasilitas mencuci tangan yang tepat, usia anak yang lebih tua, dan tidak memiliki fasilitas sanitasi yang lebih layak merupakan variabel-variabel yang secara signifikan berhubungan dengan kemungkinan praktik pembuangan tinja balita yang tidak aman. Kata kunci: Pembuangan tinja bayi, pendidikan ibu, sanitasi, cuci tangan, Indonesia ABSTRACT Previous studies show that unsafe disposal practices of child feces increase the risk of diarrhoeal diseases among children including in Indonesia. Consequently, a comprehension of the factors behind such practices is pivotal in halting the transmission of diarrhea. However, the factors associated with unsafe disposal practices of child stool in Indonesia are not yet well understood. This study investigated the factors associated with unsafe child feces disposal practices in Indonesia. Data from the Indonesia Demographic and Health Survey (IDHS) 2012 were analyzed. Probit regression models were fitted to the data with average marginal effect (AME) and its 95 % confidence interval (CI) as the measure of association. The explanatory variables were categorized into three categories: spatial variables, environmental variables, and socio-demographic variables. Listwise deletion was performed which resulted in a final analytic sample of 16,368 under-5 children residing in 13,685 households. It is observed that the prevalence of unsafe child feces disposal was 42.63% (95% CI: 41.87-43.38). Living in urban areas, lower levels of maternal education, not having a proper handwashing facility, older child age, and not having improved sanitation facility were the variables found to be associated with higher probability of unsafe child feces disposal practices. Keywords: Child feces disposal; maternal education; sanitation; handwashing, Indonesia
INTRODUCTION The Sustainable Development Goal (SDG) target 6.2 aims at ending open defecation by improving access to and equity of sanitation and hygiene, with particular reference to the needs of women and girls and those in vulnerable situations
(WHO/UNICEF JMP, 2017). However, in 2015, it was estimated that 2.3 billion people globally still lacked basic sanitation service (WHO/UNICEF JMP, 2017). It is known that inadequate water supply and poor sanitation are attributable to morbidity and mortality particularly among children (Ezeh, Agho, Dibley, Hall, & Page, 2014). In 2012, more
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Jurnal Ekologi Kesehatan Vol. 17 No 1, Juni 2018 : 1 - 10
than 300,000 under-5 deaths could have been prevented through improvements in water and sanitation in low- and middle-income countries (Prüss-Ustün et al., 2014). In many different cultures, caretakers commonly believe that children feces are not harmful (Almedom, 2007; Rauyajin et al., 1994; WHO/UNICEF JMP, 2006; Zeitlyn & Islam, 1991), and thus they often do not wash their hands after cleaning their children (Jinadu, Esmai, & Adegbenro, 2004). However, this notion need not be accurate as there is evidence that suggests children’s feces could pose a higher risk than those of adults as it contains more pathogens that can cause diarrhea (Feachem, Bradley, Garelick, & Mara, 1983). Therefore, unsafe disposal of children feces could emanate higher diarrhoeal risk, which is supported by a study done by Aulia et al. (1994) where they found that Indonesian children whose stools are disposed of in the open were more prone to contracting diarrhea. A more recent study by Cronin, Sebayang, Torlesse, and Nandy (2016) also found that children in Indonesia had elevated the risk of diarrhea when their feces are not disposed of safely. Despite this evidence, according to the 2012 Indonesia Demographic and Health Survey (IDHS), one in three children (35 percent) were reported to have their feces disposed of unsafely (Statistics Indonesia, Indonesia National Population and Family Planning Board, Ministry of Health-Republic of Indonesia, & ICF International, 2013). In fact, this figure has increased from 29 percent in 2007 based on the 2007 IDHS (Statistics Indonesia, Indonesia National Family Planning Coordinating Board, Ministry of HealthRepublic of Indonesia, & Macro International, 2008). This increase albeit small should not be overlooked. The Government of Indonesia (GoI) targets universal coverage of improved sanitation by 2019. The management of feces passed by children need not be safe even in households with access to improved sanitation facility (Majorin et al., 2014). However, the indicators used are usually from household level indicators which often disregards sanitation of children under-five years of age. More evidence is needed to support the GoI in formulating and
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implementing relevant policies to reduce unsafe disposal practice of children feces. However, the drivers of safe child feces disposal practices in Indonesia are not yet well understood. Therefore, this study is aimed at investigating the factors associated with unsafe disposal of children feces in Indonesia.
MATERIALS AND METHOD Data Source This study was a further analysis of secondary data of a population-based crosssectional survey of the 2012 Indonesia Demographic and Health Survey (henceforth the 2012 IDHS). The 2012 IDHS is the seventh IDHS aimed at providing information on fertility, family planning, and maternal and child health (Statistics Indonesia et al., 2013). For this study, two recodes were used, the Household Recode (HR) and the Children’s Recode. More detailed information about the sampling method and procedures of IDHS and fieldwork team can be read elsewhere (Statistics Indonesia et al., 2013).
Dependent Variable The only dependent variable in this study was unsafe child feces disposal practice. Child feces disposal practice was administered in the 2012 IDHS by asking “The last time (NAME) passed stools, what was done to dispose of the stools?” The possible responses comprise: (1) use toilet or latrine, (2) throw in the toilet or latrine, (3) throw outside the dwelling, (4) bury in the yard, (5) rinse away, (6) not disposed of, and (7) other. This variable was then recoded into a dichotomous variable, coded as 0 for “safe” and coded as 1 for “unsafe” based on the definition from the World Health Organisation (WHO)/United Nations Children’s Fund (UNICEF) Joint Monitoring Program (JMP) for water supply and sanitation (see Table 1). The safe practice of child feces disposal includes “use toilet or latrine,” “throw in the toilet or latrine,” and “bury in the yard” (WHO/UNICEF JMP, 2006).
Unsafe disposal of child feces in indonesia...(Sri I, Puguh P)
Table 1. Classification of safe and unsafe child feces disposal practices Sanitary Child Unsanitary Child Feces Disposal Feces Disposal Practices Practices Child used toilet or Put/rinsed feces into latrine drain or ditch Put/rinsed feces Fecesthrown into the into the toilet or garbage latrine Buried the feces Feces left or buried in the open Do not know Source: WHO/UNICEF JMP (2006)
Explanatory Variables In this study, 14 potential explanatory variables were included in the analysis. These variables were based on previous observational studies on child feces disposal practices in developing countries and other related topics (Azage & Haile, 2015; Bawankule, Singh, Kumar, & Pedgaonkar, 2017; Irianti & Prasetyoputra, 2015; Majorin et al., 2014; Prasetyoputra & Irianti, 2013). These variables were classified as environmental, spatial, and sociodemographic characteristics. The environmental variables include drinking water source (piped, other improved, unimproved); location of drinking water source (in own dwelling, in own yard/plot, elsewhere); sanitation facility (improved, unimproved, no facility/open defecation); and presence of handwashing facility (no, yes). The classification of improved and unimproved drinking water source and sanitation facility also follows the definition from the WHO/UNICEF JMP for water supply and sanitation (WHO/UNICEF JMP, 2006). Improved drinking water sources include public tap/standpipe, tubewell/borehole, protected dug well, protected spring, and rainwater collection. While, unimproved drinking water sources include: unprotected dug well, unprotected spring, cart with small tank/drum, bottled water, tanker truck, and surface water. Moreover, improved sanitation facilities include flush/pour flush (to a piped sewer system, septic tank, pit latrine), VIP latrine,
pit latrine with slab, composting toilet. While, unimproved sanitation facilities include: flush/pour flush to elsewhere, pit latrine without slab/open pit, bucket, and hanging toilet/hanging latrine. Furthermore, the spatial variables considered in this study include the region of residence (Sumatra, Java, Bali & Nusa Tenggara, Kalimantan, Sulawesi, Maluku & Papua) and place of residence (rural area, urban area). While the socio-demographic variables comprise: age of child (
